Wednesday, June 30, 2010

I was gonna write about death again- but I do that (...reading back over old posts..) A LOT o_O
so instead I'll talk about um...oh crap this ones about death too but whatever...THE MOST SKEEVED OUT I'VE EVER BEEN.

it wasn't on the evisceration, or the lady who's leg was hanging off or any of the crazy shootings stabbings rectal bleeds or other bloody disasters I've been on. This might even come as kind of a let down, cuz people at parties are always asking me: What's like the CRAZIEST ISHT You've EVER seeeen? And this definitely was not it. But it skeeved me to the bone none the less.
We were riding with this Hasidic kid that night, a student, and some of his boys were on the Hatzolah truck that works nearby- Haztolah is the all Hasidic ambulance group- and somehow they'd gotten a call for a jumper down- it was one of their guys and I guess he'd gone from the roof of one of the all Jewish projects on the Williamsburg/BedStuy border (yes there are Jewish projects). We were nearby and the kid wanted to meet them at the hospital and lend a hand, whatever, see what they'd done, learn something i suppose, so I rode over to let him take a peek.
Hatzolah is famous for rolling deep. They call it the clown car cuz the bus rolls up and nojoke like eight little bearded EMTs will pop out, all muttering at each other in Yiddish and usually dressed in tshirts and sneakers. But for some reason, that night, there was no one there, they all musta hopped out and scattered, or maybe they all decided to go in and notify the hospital together, the way girls flock to the bathroom. Either way, it was just this one little sad yarmulka'd fellow left to bring in the patient. Even my student was nowhere to be found.

I really don't like to get involved in other people's jobs. It's wrong for so many reasons but you can't roll into the hospital with a traumatic cardiac arrest and no one's doing CPR, no one's giving ventilations... It's not because the guy might make it- that was definitely not going to happen- it's just a really bad look. it's like showing up to play baseball wearing a tutu. You dont do it. So like a idiot I gloved up and positioned myself on the stretcher to start pumping the guy's chest.
Considering that he'd come down from a PJ, i was surprised that the dude wasn't splattered. He was white- literally white not just racial construct white- pale as a piece of paper, probably his internal organs had exploded and the blood was scattered inside somewhere, and his feet were pointing in all the wrong directions, surely from having been landed on. They said he'd just gotten out of woodhull's psych ward and that Jews who suicided weren't allowed to be buried in Jewish cemeteries but since no one had seen him jump, he might've been pushed or it might've been a freak accident and he'd get the benefit of the doubt.

Anyway, on my third or so compression, one of the man's chest hairs caught me right where the glove stops and my wrist begins- that tendon right there? YO. It was like the long finger of Father Death tickling my soul and NOT in a good way. I can't tell you what it was that eeeked me so much about that all i know is within 2.7 seconds I was off that stretcher and halfway across the street yelling "OH HELL NO!!" and making all kindsa faces. By that time, some other Hasids had materialized and took over but I couldt've cared less to be honest with you, I was DONE.

Wednesday, June 23, 2010

One of the biggest decisions a medic has to make is Grab-n-Go or Stay-n-Play.
Most of the time it's relatively simple- trauma's are always grabngo as I've talked about before, because trauma patients really need a surgeon to help them, so whatever we do to 'em we do it enroute to the hospital, ideally. Most medical situations are the opposite: we 're equipped to do for an asthma or heart attack what any ER would do in the first line of treatment anyway, so it's worth taking the time onscene to get the IV, the EKG, do the full workup.
Kids can seem like they fall into the inbetween category. When a kid is critically ill it feels like a trauma job because people are freaking out, tensions are high, there's a certain element of chaos that makes you wanna go go go and be gone no matter what. Adding to that tension is the high compensation/sudden plummet thing that kids do. Unlike adults, who will spend hours sometimes circling the drain, kids tend to compensate and compensate and compensate- sure they're struggling but they look okay, right? and then suddenly they'll just turn blue and crash completely and die in a matter of seconds. A good medic knows that, and it makes us anxious to pass the potato, but we also know that what happens in those fleeting moments between life and death determines whether a patient makes it or not.

So this kid was big for 13. A hundred and seventy-five pounds actually and foulmouthed to boot, and he was standing outside his house at 3AM flagging frantically at us. He stumbles over to the ambulance as we roll up, his pants falling down. "I'm gonna fuckin' die!" he screams and jumps in the bus, crapping himself as he goes. Now, people saying they're gonna die- you know that's neither here nor there. You get the people that say it over a fight with their ex and then you get the people that look fine, say they're gonna die and then do exactly that, which yes is creepy as hell. But you can't fake crapping your pants- it's always a bad sign whether asthma attack, heart attack or trauma, it means the body is giving up less essential functions to concentrate on the only ones that matter. The mom came running up a second later. The boy laid out on the stretcher, gasping and started turning blue. I mean, the kid literally used his last drip drops of life force to make it to us and then everything started giving out.

Moments like that, the world goes into slow-mo. Actually, we were moving pretty fast, but it felt like hours as I moved across the bus and pulled open our medicine kit to find a syringe and the epinephrine. My partner was dealing with the oxygen, setting up an albuterol treatment, and I'm wondering if the kid'll even be breathing by the time we get it to him, but I can still hear his tight little gasps and his mom sobbing for us to help him.
The stupid epi comes in stupid little vials that you have to crack open and extract the liquid from painfully carefully with a needle. It sucks. drip drip drip. 0.1 mgs and I need 0.3. Drip drip drip. Gasp...gasp...gasp. "Please, he's turning blue! Help him!" I hear the shushhhh of the oxygen (Finally...only seconds later though...) and Mike straps the mask onto the kid's face as the treatment seeps out in a little cloud. It's a start, but epi is the real turnaround medication. Finally I hit 0.3 mgs, grumbling, and I stab the kid in the arm and push the meds in and exhale.

But he's looking worse. "I think we're gonna haveta tube," Mike says. I nod, throwing the defibrilator pads on the boys chest so we can get a read out on the monitor and shock if we have to. A tube is a last ditch effort for someone in respiratory failure. It's for when the body simply can't breath for its self anymore and so it allows us to do the breathing for the person. His heart rate turns out not to be so bad- it's 110, which is about normal for someone having an asthma attack. (Kinda bad woulda been much much faster that, 140 or 160 but really really bad woulda been slow, anything below 70 would signal him sliding straight down the drain at any second.) His oxygen saturation is crap though. That's the percent of o2 that's gettin to his blood. It's normally %97-%100. Someone struggling to breath might be down to %80something and we'd be pretty concerned. This kid's is %54.

Mike opens his mouth to intubate but the boy is clenched up. It means he still has some fight in him, but still...I take a quick look to see if there's an IV to be gotten, but he's large and nothing popping up. The moment to move has come. The first lines of medicine are onboard, the oxygen is flowing. Stay and play is over. I put on the machine gun scatter siren and blast off to St Johns, giving the notification breahtlessly as I go ("13 year old...male...(pant pant)...imminent respiratory arrest...(pant pant)...vital signs are as follow...(pant pant)) and make it there in 2 minutes flat. Mike has popped an IV and some more meds in on the way, bless his soul. I can tell the epi has done its thing before i even get out of the driver's seat- the kid is coughing and crying. People who are about to code don't cry. He's moving air. I hop out and by the time we roll him inside Little Big Man is actually talking, almost in complete sentences. "Jesus Christ!" he pants. "I almost fuckin' died!!"

Tuesday, June 22, 2010

I guess if I'd been shot twice in the face there'd be some people I'd like to call too, but if the paramedic told me to lay down and stop moving that's what I'd do. Not this dude. This dude is too busy cursing someone out on the other line and swatting off the EMTs while they try and fit a c-collar on him.
I hop on the bus and put on my I'm-not-kidding voice: "Sir, you have 3 bullet holes in your face. That means 2 went in and only 1 came out, so there's a bullet rattling around somewhere and if you move too much it very well might dislodge and end up in your brain."
"But..."
"And then you'll be dead."
He relents and lays onto the board, lookng irritated at me . (I'm not the one that shot him...whatever...) the emts collar him up and strap him down and I yell to the driver to take a not-2-crazy ride to King's County. If you don't say that you end up hitting a bump at mach 7 and all kindsa mess can ensue. Especially because when the ambulance roars off me and my partner grab the biggest needles we can find and start poking the patient with 'em. To get the IV of course- not cuz he's being difficult.

The first bullet entered the ridge of his cheek bone just below the eye, transversed his face somewhere between his eyes and nose and exited through the opposite cheek. The second bullet entered slightly lower than the first and is who-knows-where. Miraculously, the dude's vital signs are all stable, he's mentating perfectly well and the only bleeding is a little clottiness around his nose. Still...trauma patients and kids (see next post) can look perfectly fine one second and die the next, so we keep a steady eye on him.
Before we get to County he swears he doesn't know who shot him, gives a false name and fields two more curse-laden phone calls.

About Me

Daniel José Older's work has appeared in Strange Horizons, Crossed Genres, The Innsmouth Free Press, Flash Fiction Online, and the anthology Sunshine/Noir, and is featured in Sheree Renee Thomas' Black Pot Mojo Reading Series in New York City. When he's not writing, teaching or riding around in an ambulance, Daniel can be found performing with his Brooklyn-based soul quartet Ghost Star), with whom he recently completed a multimedia live music and dance documentary about the end of slavery in new york entitled City of Love and Disaster.
SELECTED FICTION:
Salsa NocturnaTenderfootThe Crate